Richmond Agitation-Sedation Scale
Richmond Agitation-Sedation Scale (RASS) · Also known as: RASS, Sedation scale, Agitation scale
The Richmond Agitation-Sedation Scale (RASS), developed by Sessler et al. in 2002, is a 10-level ordinal scale for assessing level of consciousness, agitation, and sedation in critically ill patients. It ranges from +4 (combative/violent) through 0 (alert and calm) to -5 (unarousable), enabling precise titration of sedative and analgesic medications in ICU settings.
Read the full method
Sign in with a free account to read this section.
Method map
The neighbourhood of related methods — select a node to explore.
When to use it
RASS is applied hourly (or per protocol) in all ICU patients on sedatives, analgesics, or mechanical ventilation to guide medication titration. It is used in combination with pain assessment (Behavioral Pain Scale or CPOT) to manage sedation-analgesia balance. RASS is applicable to alert patients as a baseline, though monitoring in conscious, communicative patients is less critical.
Strengths & limitations
- Simple, quick assessment (< 1 minute) using bedside observation without equipment
- Robust psychometric properties: high inter-observer reliability and validity across diverse ICU populations
- Bidirectional scale enables assessment of both agitation and over-sedation with single tool
- Target RASS (0 to -1) aligns with evidence on improved outcomes (reduced ventilator time, delirium, weakness)
- Facilitates communication about sedation status among ICU team members
- Does not assess cognitive function (delirium, confusion); use CAM-ICU in conjunction with RASS for delirium detection
- Sedating medications and paralysis agents mask patient responsiveness; RASS may appear low even if patient perceives pain
- Stimulation itself (physical touch, loud voice) can cause agitation in some patients, potentially biasing score
- Does not differentiate causes of agitation (pain, anxiety, hypoxia, delirium, withdrawal); clinical context required
- RASS may not be reliable in patients with altered brainstem function (severe stroke, seizures) where reflex responses dominate
Frequently asked
What is my target RASS score?
For most ICU patients, target RASS is 0 to -1 (alert and calm to drowsy). This balances comfort with safety and promotes earlier weaning from mechanical ventilation. Your ICU team will tailor target based on your condition and sedation needs.
Why does my RASS keep changing?
RASS is assessed hourly and adjusted based on your needs. If you are restless or agitated (RASS > 0), sedatives or pain medications increase. If you are oversedated (RASS < -2), medications decrease. This dynamic adjustment improves your comfort and recovery.
Can I have pain if my RASS shows I'm sedated?
Yes. Sedation and analgesia are separate. Even sedated patients may perceive pain. Your doctors assess pain using the Behavioral Pain Scale or CPOT and adjust analgesics independently of RASS. Always tell staff if you feel pain.
Is RASS the same as the Glasgow Coma Scale?
No. RASS is for ICU sedation and agitation assessment; GCS is for neurological status in brain injury. They are different tools for different purposes. Your ICU team may use RASS; neurology may use GCS.
Sources
- Sessler, C. N., Gosnell, M. S., Grap, M. J., et al. (2002). The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 166(10), 1338-1344. DOI: 10.1164/rccm.2107138 ↗
- Ely, E. W., Inouye, S. K., Bernard, G. R., et al. (2003). Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the ICU (CAM-ICU). JAMA, 286(21), 2703-2710. DOI: 10.1001/jama.286.21.2703 ↗
How to cite this page
ScholarGate. (2026, June 3). Richmond Agitation-Sedation Scale (RASS). ScholarGate. https://scholargate.app/en/clinical-assessment/richmond-agitation-sedation
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
- Behavioral Pain ScaleClinical Assessment↔ compare
- Glasgow Coma ScaleClinical Assessment↔ compare
- Modified Early Warning ScoreClinical Assessment↔ compare